Records Disposition Form
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RECORDS DISPOSITION FORM
UNTHSCRMD 101
RECORDS AND INFORMATION MANAGEMENT
Date Issued: 4-1-97
Date Revised: 10/13/2009
Department
Name of Person Completing Form
Department Account Number
Phone
Subject: Request To Dispose Of Records In Accordance With The University Of North Texas Health Science
Center Retention Schedule. I hereby certify that the following records described on the attached pages have no
further legal, fiscal, administrative or historical use to this department for the reasons indicated. (Please Check)
1.
The records have fulfilled their retention requirements.
2.
Microphotographic reproductions of the records, complying with the minimum standards established by the American National Standards
Institute (ANSI), have been made and certified as original records for legal purposes. The type and quality of the reproduction will fulfill
the retention requirements of the original records.
3.
The records are essential (vital) records as defined by Texas Government Code 441.052, Act of the 70th Legislature. A preservation
duplicate of the original microphotographic reproduction has been made and preserved in compliance with this
Statute.
4.
The records are non-essential and therefore a preservation duplicate is not required.
5.
Imaged reproductions of the records, comply with the TSLAC Electronic Records Standards and Procedures State Agency Bulletin One, have
been made and certified as original records for legal purposes. The type and quality of the reproduction will fulfill the retention requirments.
Record Medium
(Check Only One)
Paper
Microfilm
Electronic
Final Disposition Method
Trash
Recycle
Shred
Number of Boxes/Containers
Volume (in Cubic Feet) Eligible for Disposal
Record Series Title
Dates of Records: Beginning
Ending
Agency Code
763
Retention Period
Please complete the attached Disposition Log. It is recommended that each office retain a copy of this record.
Each department is responsible for properly boxing, labeling, and inventorying all records transferred to Records
Management. (If additional pages are needed for transfer, please make copies)
Confidential records must remain inaccessible to unauthorized personnel during this process. Although certain files are classified as open
records, they should be shredded for final disposition.
I certify that I am authorized to act for this office or department on matters pertaining to the disposition
of university records.
Signatures
Person Disposing of Documents
Date
Vice President or Dean
Date
Date
Legal
Date
Department Head
Audit
Date
Records Management Officer
Date
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